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Edad Cronológica, EdadCardiovascular y Edad
FuncionalDr. Enrique Sánchez Delgado.
XVIII CONGRESO NACIONAL DE MEDICINA
INTERNA. ¨La Medicina Interna, una Vía Hacia todos los Sistemas¨ Dedicado al “Dr. Denis Saavedra”.
En Memoria del Dr. Felix Zelaya Rivas
Edades: 1.- Cronologica
Vida: ¨enfermedad de transmisión sexual que culmina irremediablemente con la muerte¨.
Con la concepción comenzamos a vivir pero también comenzamos a morir.
Solo en Disney dice ¨y vivieron felices para siempre ¨ Los Hermanos Grimm eran realistas y sus cuentos terminan
con la frase: ¨und wenn sie nicht gestorben sind, dann leben sie noch
heute¨ ( y si no se han muerto, todavía están vivos).
Muerte prematura: Según las épocas:
Hace un siglo se estableció la edad de jubilación en la época de Bismarck en 65 años porque era lo mas que vivía la mayoría de la gente.
Actualmente la expectativa de vida se acerca a los 80 y hasta 85 años y no es nada raro vivir el siglo y hasta unos 120 años como edad limite real.
La francesa Jeanne Calment, vivió 122 años y murió en 1997.
Telomere length, cancer incidence and mortalityJAMA. 2010.0707;304(1):69-75
Exceptional Parental Longevity Associated with Lower Risk of Alzheimer's Disease and Memory DeclineJ Am Geriatr Soc. 2010.07.23
The offspring of parents with exceptional longevity (OPEL) had a lower incidence of Alzheimer's disease (hazard ratio=0.57,
RRR 43%)
Low cardiac function may accelerate brain aging 6 August 2010 Circulation 2010; Advance online publication
A decreased cardiac index (cardiac output) is associated with decreased brain volume – a sign of brain aging.
Dividing the participants into tertiles based on their cardiac index values revealed that those in the bottom (<2.44 l/min/m2) had a 36% lower brain volume, respectively (p=0.04), than those in the top tertile (>2.92 l/min/m2).
These 36% brain volume differences correspond to
1.9-year increases in brain age. The correlation between cardiac index and brain volume was strongest among participants aged <60 years (p=0.01)
This finding suggests that heart and brain health go hand in hand.
Nota E. Sanchez -2000: “Lo que es bueno para el corazon es bueno para el cerebro y viceversa”
LA RELACION FRECUENCIA CARDIACA Y TRABAJO MIOCARDICO. Ver INDICE PULSO MASA. E. Sánchez Delgado, Lancet 1999
Frecuencia
Latidos min
Una hora Un dia Un mes Un año
50 3000 72 000 2 160 000 25 920 000
60 3600 86 400 2 592 000 31 104 000
70 4200 100 800 3 024 000 36 288 000
80 4800 115 200 3 456 000 41 472 000
90 5400 129 600 3 888 000 46 556 000
100 6000 144 000 4 320 000 51 840 000
Meneses Daniel. El corazón en tus manos. 2008
Las estrellas muy grandes, de gran masa y calor, pulsan muy rápido, consumen pronto su energía, viven rápido e intenso y mueren jóvenes.
Es un principio de las leyes de la Termodinámica que aplica desde el colibrí hasta los pulsares y supernovas en las galaxias
La meta óptima:
Buscar el “Eustress”El stress saludable…su propio paso…
(Hans Selye)
"If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health."
~Hippocrates
Edad mental: Ej. AlzheimerSra. de 80 es como una niña
Edad Sico-afectiva -social (optimista,
creativo, activo, motivado, con apoyo social, con un legado)
Ej. Mandela ( joven de 90 a.).
Edad Aparente (sin ayuda)
Nace en Ulm, Alemania, 1879
(ESD en Ulm, 1980-86 y adelante)
Note:
Arrugas,
Aneurisma de Aorta (causa de muerte)
Causa de ambos?
Muere en Princeton, USA, 1955
IQ ranks among the strongest predictors of cardiovascular disease, and is
second only to cigarette smoking ESC Britain's Medical Research Council 2010
Nota ESD: sin fumar Einstein podría haber sido muy longevo
Lower intelligence scores were associated with higher rates of cardiovascular disease and total mortality at a greater level of magnitude than found with any other risk factor except smoking.
This relative index of inequality for the top five risk
factors was found to be 5.58 for cigarette smoking, 3.76 for IQ, 3.20 for low income, 2.61 for high systolic blood pressure, and 2.06 for low physical activity.
Nota ESD: “Lo que es bueno para el cerebro es bueno para el corazon”
Nota ESD: Inteligencia en los hijos de mèdicos y profesionales exitosos.
Can dementia be prevented? Eliminating diabetes and depression, and boosting education, most likely to ward off dementia. BMJ 2010 (August 5);341:c3885
K Ritchie et al enrolled 1433 community dwelling people who lived in the city of Montpellier, France, and who were aged 65 orolder at baseline between 1999 and 2001. Remaining predictors of dementia were crystallisedintelligence (which is based on knowledge and experience—for example, vocabulary and general information (PAF 18%), depression (PAF 10%), fruitand vegetable consumption (PAF 6%), diabetes (PAF 5%), and the presence of the apolipoprotein E (ApoE) 4 allele (PAF 7%).
The results indicate that a theoretical elimination of depression and diabetes and an increase in education, fruit and vegetable consumption would reduce the total burden of dementia by about 21%.
For comparison, a theoretical elimination of the ApoE 4 allele would lead to a reduction of about 7%.
Hypertension and hypercholesterolaemia in midlife are also risk factors for
developing dementia.
Nota E Sánchez D (Revista Summa, Dic.2009):
“Lo que es bueno para el corazón es bueno para el cerebro”
Hay evidencia de que Diabetes de larga data equivale a enfermedad
cardiovascular y envejecimiento prematuro. 5 April 2011 J Gen Intern Med
Factores de riesgo son los mismos que para enfermedades cardio y cerebrovasculares.
Ver INTERHEART e INTERSTROKE
Heavy Smoking in Midlife Increased Dementia Risk Two
Decades Later
Heavy smoking in midlife is associated with more than a doubling of
risk for dementia in older age, An ethnically diverse group of some
21,000 adults aged 50 to 60 were interviewed about their smoking
habits between 1978 and 1985. Researchers then assessed the
participants' medical records from 1994 to 2008 and found that a quarter
had developed dementia, Alzheimer disease, or vascular dementia.
In fully adjusted analyses, the risk for dementia rose as the amount
of smoking increased. In particular, participants who smoked more
than two packs a day in midlife had more than twice the risk for
dementia, AD, or vascular dementia two decades later, compared
with those who'd never smoked.
"It is well recognized that smoking augments oxidative stress and
inflammation, which are also believed to be important pathophysiologic
mechanisms in AD."
Archives of Internal Medicine article 2010.Oct. 26
El joven vive como si fuera inmortal
Pero…
“El Diablo cuenta los años concienzudamente”
Albert Einstein
(poco antes de morir)
Edad Arterial: edad real
Somos tan viejos como nuestras arterias.Leonardo da Vinci
Longevity is a vascular question, which has been well expressed in the axiom that man is only as old as his arteries. To a majority of men death comes
primarily or secondarily through this portal. The onset of what may be called physiological arterio-sclerosis depends, in the first place, on the quality of arterial tissue which the individual has inherited, and secondarily on the amount of wear and tear to which he has subjected it.
—Sir William Osler, 1891
Relative risk of a first cardiovascular disease
(CVD) event according to ageHeart 2010;96:1-4
Afectación arterial extensa en los ancianosJACC 2011 (25 Abril)
FACTORES DE RIESGO CARDIOVASCULAR A NIVEL MUNDIALEffect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study)
S.Yusuf . Lancet 2004; 364: 937-52
1.- TABAQUISMO : Aumento de Riesgo: 1 Paquete = 4X; 2 Paquetes = 9X
2.- LÍPIDOS : Aumento de Riesgo: 3.25 X …..más 1 Paquete = 13 X
3.- ESTRÉS permanente o Depresión: Aumento 1.6X a 2.7 X (intensidad)
4.- DIABETES : Aumento 2.4 X
5.- HIPERTENSIÓN : Aumento 1.9 X (más Diabetes = 4.7 X )
6.- OBESIDAD ABDOMINAL : Aumento 1.6 X (importante en L.A.)
7.- FRUTAS Y VEGETALES : Reducción del 30 por ciento = 0.7 X
8.- ACTIVIDAD FÍSICA: Reducción del 15 por ciento = 0.85 X
9.- BEBER CON MODERACIÓN : Reducción del 10 % = 0.9 X
LOS NUEVE FACTORES:…. Riesgo aumenta más de 300 veces = más de treinta mil por ciento !!!
JÓVENES: EFECTOS MÁS FUERTES, especialmente Tabaquismo y Lípidos.
FRAMINGHAM RISK SCORE (FRS).NCEPEstándar de oro para cálculo de riesgo CVS
Evaluación del Riesgo CardiovascularEvolución Histórica yResumen de Contenido Enfermedad Cardiovascular principal causa de muerte. Prevención!
Década de los 90: IMC y Score de Riesgo de Framingham (FRS) se vuelven de uso común.
La FC en reposo apenas se menciona como Factor de Riesgo y el IMC se considera FR de segundo rango.
Lancet 13 de Marzo 1999: E. Sánchez-Delgado publicasus resultados preliminares con el Índice Pulso Masa (IMC.FCR/1730), mayor de 1.3 como predictor de riesgo cardiovascular, demostrando su elevada correlación con el FRS (Framingham).
También lo menciona como elemento a considerar para los beneficios o riesgos de fármacos cardiovasculares y metabólicos.
Muestra evidencia poblacional de que la reducción calórica prolonga la expectativa de vida.
Lo presenta en el Congreso Mundial de Medicina Interna en Cancún, México 2000.
Evaluación del Riesgo CardiovascularEvolución Histórica yResumen de ContenidoContinuación… En 2001 el NCEP ATP III (FRS), se convierte en el estándar internacional, de uso más
común que otros Scores de Riesgo.
En esta década, 2001-10, se reconoce cada vez más la importancia del IMC como FR de primer rango, y la “pandemia” global de obesidad.
En 2004 se publica el Estudio INTERHEART, que identifica nueve FR comunes en 52 países.
En 2007, la ESC menciona en sus guías la FCR como FR
En Feb. 2008, el Estudio de Framingham incorpora por primera vez el IMC en sus tablas de un modelo simplificado con sólo datos clínicos.
En Sept. 2008, Congreso de la ESC en Munich, Alemania, los estudios BEAUTIFUL y EUROPA confirman a la FCR como FR.
Evaluación del Riesgo CardiovascularEvolución Histórica yResumen de Contenido
Continuación…
Sept. 2008: E. Sánchez-Delgado presenta el Índice Pulso Masa actualizado en el
Congreso Mundial de Medicina Interna en Buenos Aires, Argentina.
Presentado en San José, Costa Rica, 24.07.09, Simposio CA y Caribe de Actualizacion en Enfermedad Cardiovascular
Presentado en el Tecnológico de Monterrey, México, 22.08.09, en el II Congreso Innovación en Cardiología y Medicina Vascular. Presentado en Congreso AMICAC El Salvador, Julio 2010, AMIG, Guatemala, Sept. 2010.
Desde Sept. 2008 al 2010, otros estudios, incluyendo el estudio SHIFT en el ESC de Estocolmo, Agosto 2010 confirman el papel de la FCR como FR y se acumulan datos de la importancia de los elementos del Índice Pulso Masa en los beneficios y riesgos de fármacos cardiovasculares y metabólicos.
Concluiremos con la Valoración clínica inicial y exámenes complementarios, para el manejo individualizado del riesgoy la prevención cardiovascular.
We compared prospectively, in a preliminary group of 20 patients
the Pulse by Mass index with the Framingham Risk Score.The correlation was highly significant (r=0·94; p<0·05), especially in
patients over 40 years, despite the Pulse by Mass index beingmore sensitive for younger patients.
45
Europrevent 2010, Praga --- (ver E. Sanchez Delgado Lancet 1999)
Arterial age
CIMT reference data published for Andean Hispanics
9 June 2010 Atherosclerosis 2010; Advance online publication
CIMT in participants aged 20–29, 30–39, 40–49,
50–59, 60–69, and 70–80 years
The 95th percentiles in these age groups were 0.67, 0.67, 0.75,
0.82, 0.81, and 0.98 mm, respectively, in men
0.58, 0.61, 0.69,
0.76, 0.86, and 0.91 mm, in women.
Carotid ultrasound effective screening tool for CAD
The mean CCA IMT was ≥0.9 mm in 46.0% of 150 patients…60y…with LVSD
and the absence of plaques combined with the presence of a mean CCA IMT <0.9 mm gave a 98% negative predictive value for ischemic LVSD, to rule out CAD as the etiology of LVSD.
Am Heart J 2010; 159: 1059–1066
IMC 30+…También para calculo de dosis !...Clínica !
Coronary Calcium Score the Left Coronary Artery Two asymptomatic men, 51 and 81 years of age
Egyptian princess the first person in human history with diagnosed coronary artery disease (3500 years ago ). ESC. 2011, May 17. Princess Ahmose-Meryet-Amon who died in her 40s had calcifications in every vascular bed visualised…Arterial
age ???. More luxury foods - more meat, butter and cheese. Foods were preserved in salt.
Risk of Major Coronary Events with Increasing Coronary-Artery Calcium Score.
Edad funcional:Ej. quien tiene una capacidad funcional de menos de 4 METS en la prueba de esfuerzo es de alto riesgo quirúrgico anestésico.
Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study BMJ 2009 339: b4460
Analyses for specific causes of death showed that participantswith low walking speed had about a threefold increased risk of cardiovascular death (2.92) compared with participants who walked faster.
Las canas son vanas, las arrugas inseguras…
…La verdadera vejez…
es cuando arrastras los pies !
citado por
Mercedita Campos de Martínez Maestra de Generaciones y madre de respetados médicos.
Nació en 1905 (año que Einstein publicó sus artículos pioneros de la Relatividad), y vivió 103 años.
O como le dice un anciano a su amigo:
Hermano, es lo peor llegar a viejo
Le contesta su amigo:
No hermano, lo peor es no llegar.!!!
La Meta:(para avanzar con éxito en el tiempo)
Comprimir los años de Morbilidad y/o Discapacidad en la etapa final de la vida.
Vivir plenamente y sanamente el mayor
tiempo posible.
Para una Edad Exitosa (Successful ageing):
Mantenerse activo, física… y mentalmente !!!.
Una onza de prevención vale
más que un quintal de curación.
Apégate a tres médicos, siempre que puedas:
Las Dras. Tranquilidad, Alegría+Actividad y Dieta.
Aprovechar las ventajas de la medicina moderna en cuanto a:
Diagnóstico oportuno:
IPM, FRS, CRP, A1c, Crea, EGO, EKG, GIMC, SCaC
Prevención 1ª- y 2ª
Tratamientos efectivos y a tiempo.
7 Metas Básicas en Prevención DM+CVSSánchez 2000 (Prevención Cardíaca, Cerebral y de Cáncer)
1. Educación y Nutrición. Cuidar el INDICE PULSO MASA
2. Ejercicio y Manejo del Stress3. Glicemia y HbA1c. (Fármacos individuales o combinados,).4. Presión arterial y Microalbuminuria
(IECA/ARA, BB, Diuréticos, CA, otros).5. Control de Lípidos (Estatinas y otros).6. Aspirina (75-150 mg)/Antiplaquetarios.
7. No Fumar.
Regla 3-30 de MBE: RRR …50 a 80%NNT: 16/2y, 32/a, (Prev.2ª)NNT: 7/10y, 70/a, (Prev.1ª)
Remarkable success in reducing MI in UKEuropean Heart Journal. June 8, 2011
9453 men and women in British civil servants had a drop of almost 75% in MIs over a 20-year period, attributed mainly to better lifestyle and treatment of risk factors.
They are health conscious, they want to remain in the study, and they are having five-yearly screening check-ups .
There was also a modest contribution from increased consumption of fruit and vegetables.
Over half of this reduction (56%) could be explained by improvements in four of the main risk factors for MI: declining levels of non-HDL cholesterol, an increase in HDL cholesterol, reduced blood pressure, and a reduction in the number of people who smoked.
At the same time, there was a steady annual rise in BMI for both men and women, and this was associated with an increase in the risk of heart attack of 11% over the 20-year period. There will inevitably be an age-associated rise in MI as this cohort grows older
….Cuidar el INDICE PULSO MASA…!!!.
Muchas gracias por su atención !
Preguntas y comentarios son bienvenidos !.
Walking speed linked to adverse outcome risk after cardiac surgery
12 November 2010 J Am Coll Cardiol 2010; 56: 1668–1676
All patients…76 y… were timed while walking a distance of 5 meters, and classified
…as slow (n=60; walked 5 meters in ≥6 seconds) or normal walkers (n=71; walked 5 meters in <6 seconds).
slow gait speed remained significantly associated with a 3.05-fold increased risk for postoperative mortality or major morbidity.
IQ ranks among the strongest predictors of cardiovascular disease, and is second only to cigarette smoking ESC Britain's Medical Research Council 100210
Lower intelligence scores were associated with higher rates of cardiovascular disease and total mortality at a greater level of magnitude than found with any other risk factor except smoking.
The relative strengths of the association were measured by an "index of inequality", which summarised the relative risk of a health outcome
(cardiovascular death) in the most disadvantaged (high risk) people relative to the most advantaged (low risk).
This relative index of inequality for the top five risk
factors was found to be 5.58 for cigarette smoking, 3.76 for IQ, 3.20 for low income, 2.61 for high systolic blood pressure, and 2.06 for low physical activity.
Heavy Smoking in Midlife Increased Dementia Risk Two
Decades Later
Heavy smoking in midlife is associated with more than a doubling of
risk for dementia in older age, An ethnically diverse group of some
21,000 adults aged 50 to 60 were interviewed about their smoking
habits between 1978 and 1985. Researchers then assessed the
participants' medical records from 1994 to 2008 and found that a quarter
had developed dementia, Alzheimer disease, or vascular dementia.
In fully adjusted analyses, the risk for dementia rose as the amount
of smoking increased. In particular, participants who smoked more
than two packs a day in midlife had more than twice the risk for
dementia, AD, or vascular dementia two decades later, compared
with those who'd never smoked.
"It is well recognized that smoking augments oxidative stress and
inflammation, which are also believed to be important pathophysiologic
mechanisms in AD."
Archives of Internal Medicine article 2010.Oct. 26
Telomere Length and Risk of Incident Cancer and Cancer Mortality
JAMA. 2010.0707;304(1):69-75.
Context Telomeres are essential to preserve the integrity of the genome. Critically short telomeres lead to replicative cell senescence and chromosomal instability and may thereby increase cancer risk.
Objective To determine the association between baseline telomere length and incident cancer and cancer mortality.
Design, Setting, and Participants Leukocyte telomere length was measured by quantitative polymerase chain reaction in 787 participants free of cancer at baseline in 1995 from the prospective, population-based Bruneck Study in Italy.
Main Outcome Measures Incident cancer and cancer mortality over a follow-up period of 10 years (1995-2005 with a follow-up rate of 100%).
Results A total of 92 of 787 participants (11.7%) developed cancer (incidence rate, 13.3 per 1000 person-years). Short telomere length at baseline was associated with incident cancer independently of standard cancer risk factors (multivariable hazard ratio [HR] per 1-SD decrease in loge-transformed telomere length, 1.60; 95% confidence interval [CI], 1.30-1.98; P < .001). Compared with participants in the longest telomere length group, the multivariable HR for incident cancer was 2.15 (95% CI, 1.12-4.14) in the middle length group and 3.11 (95% CI, 1.65-5.84) in the shortest length group (P < .001).
Incidence rates were 5.1 (95% CI, 2.9-8.7) per 1000 person-years in the longest telomere length group, 14.2 (95% CI, 10.0-20.1) per 1000 person-years in the middle length group, and 22.5 (95% CI, 16.9-29.9) per 1000 person-years in the shortest length group. The association equally applied to men and women and emerged as robust under a variety of circumstances. Furthermore, short telomere length was associated with cancer mortality (multivariable HR per 1-SD decrease in loge-transformed telomere length, 2.13; 95% CI, 1.58-2.86; P < .001) and individual cancer subtypes with a high fatality rate.
Conclusion In this study population, there was a statistically significant inverse relationship between telomere length and both cancer incidence and mortality.
Assessment age important in early atherogenic risk prediction
Markus Juonala et al 30 November 2010 Circulation 2010; Advance online publication
Data were analyzed on 4380 participants aged 3–18 years from the Cardiovascular Risk in
Young Finns Study
Carotid IMT measurements were available. Childhood risk factors comprised being in the highest quintile for total cholesterol, triglycerides, blood pressure, and body mass index (BMI)
…see Pulse Mass Index and Pulse Mass Pressure Product.
Odds ratios for childhood risk score in predicting high IMT in adulthood were higher with increasing age, at 1.37, 1.48, 1.56, and 1.57
for ages 9, 12, 15, and 18 years, respectively. risk factor measurements
are the most useful after the age of 9 years.
The ability to impact lifestyle might be greater at younger ages.
Europrevent 2010, Praga
